Provider Demographics
NPI:1174523666
Name:SELECT SPECIALTY HOSPITAL - NORTHEAST OHIO INC
Entity type:Organization
Organization Name:SELECT SPECIALTY HOSPITAL - NORTHEAST OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1139
Mailing Address - Street 1:4716 OLD GETTYSBURG RD
Mailing Address - Street 2:LEGAL DEPT
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1139
Mailing Address - Fax:717-975-9981
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:6TH FLOOR
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-344-1030
Practice Address - Fax:330-344-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1421282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000157636OtherBCBS OH
OH123635400OtherBLACK LUNG
OH2012968Medicaid
OH000000157636OtherBCBS OH
OH=========008OtherMEDICAL MUTUAL OF OHIO